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Clinical Trial
. 2011 Apr 12;108(15):6270-5.
doi: 10.1073/pnas.1102693108. Epub 2011 Mar 28.

Social rejection shares somatosensory representations with physical pain

Ethan Kross  1 , Marc G Berman, Walter Mischel, Edward E Smith, Tor D Wager
Affiliations
Clinical Trial

Social rejection shares somatosensory representations with physical pain

Ethan Kross et al. Proc Natl Acad Sci U S A. .

Abstract

How similar are the experiences of social rejection and physical pain? Extant research suggests that a network of brain regions that support the affective but not the sensory components of physical pain underlie both experiences. Here we demonstrate that when rejection is powerfully elicited--by having people who recently experienced an unwanted break-up view a photograph of their ex-partner as they think about being rejected--areas that support the sensory components of physical pain (secondary somatosensory cortex; dorsal posterior insula) become active. We demonstrate the overlap between social rejection and physical pain in these areas by comparing both conditions in the same individuals using functional MRI. We further demonstrate the specificity of the secondary somatosensory cortex and dorsal posterior insula activity to physical pain by comparing activated locations in our study with a database of over 500 published studies. Activation in these regions was highly diagnostic of physical pain, with positive predictive values up to 88%. These results give new meaning to the idea that rejection "hurts." They demonstrate that rejection and physical pain are similar not only in that they are both distressing--they share a common somatosensory representation as well.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Time course of Social Rejection and Physical Pain trials. The Social Rejection and Physical Pain tasks each consisted of two consecutively administered runs of eight trials (i.e., 16 total trials). The order of the two tasks was counterbalanced across participants. (A) Each Social Rejection trial lasted 45 s and began with a 7-s fixation cross. Subsequently, participants saw a headshot photograph of their ex-partner or a close friend for 15 s. A cue-phrase beneath each photo directed participants to think about how they felt during their break-up experience with their ex-partner or a specific positive experience with their friend. Subsequently, participants rated how they felt using a five-point scale (1 = very bad; 5 = very good). To reduce carryover effects between trials, participants then performed an 18-s visuospatial control task in which they saw an arrow pointing left or right and were asked to indicate which direction the arrow was pointing. Ex-partner vs. Friend trials were randomly presented with the constraint that no trial repeated consecutively more than twice. (B) The structure of Physical Pain trials was identical to Social Rejection trials with the following exceptions. During the 15-s thermal stimulation period, participants viewed a fixation cross and focused on the sensations they experienced as a hot (painful) or warm (nonpainful) stimulus was applied (1.5-s temperature ramp up/down, 12 s at peak temperature) to their left volar forearm (for details, see Methods). They then rated the pain they experienced using a five-point scale (1 = very painful; 5 = not painful).
Fig. 2.
Fig. 2.
Neural overlap between social rejection and physical pain. (A) A whole-brain conjunction analysis revealed that regions typically involved in both the affective [AI (−30, 11, 14); dACC (9, 26, 24)] and sensory [thalamus (6, −4, 7); S2 (62, −28, 36)] components of physical pain were also involved in response to social rejection (Ex-partner > Friend) and physical pain (Hot > Warm). (B) An ROI analysis performed on physical pain regions revealed overlap between social rejection and physical pain in regions similar to those identified by the whole-brain analysis [AI (−33, 11, 14); dACC (6, 26, 24); thalamus (6, −4, 7); S2 (59, −26, 24)]. Bar graphs demonstrate the β-values for social rejection (Ex-partner > Friend) and physical pain (Hot > Warm) extracted from each cluster. Error bars represent one SE. None of the β-values associated with social rejection differed significantly from the β-values associated with physical pain (all two-tailed paired sample t statistics < 1.75, all P values > 0.09).
Fig. 3.
Fig. 3.
Operculo-insular ROI analyses. The neural overlap between social rejection and physical pain in (A) OP1 [right hemisphere (RH): 46 voxels; x = 56, y = −23, z = 21, tpeak = 3.52; left hemisphere (LH): 43 voxels; x = −48, y = −17, z = 21, tpeak = 2.97) and (B) dpINS (RH: 24 voxels; x = 39, y = −15, z = 18, tpeak = 2.85; LH: 23 voxels; x = −39, y = −9, z = 23, tpeak = 2.75). Coordinates are in Talairach space. Bar graphs demonstrate the β-values for social rejection and physical pain in each ROI. Error bars represent one SE. We performed two separate repeated-measure ANOVAs using the β-values extracted from OP1 (Analysis #1) and dpINS (Analysis #2) ROIs. Each analysis included pain type (social vs. physical) and hemisphere (right vs. left) as within participant factors. These analyses revealed no significant main effects (OP1: all F < 0.84, all P > 0.36: dpINS: all F < 2.64, P > 0.11) or interactions (OP1: F = 0.31, P = 0.58: dpINS: F = 2.25, all P > 0.14). These findings indicate that it was not the case that one type of pain led to significantly greater activation compared with the other, or that the activations were lateralized to one side of the brain in these ROIs. (C) Bar graphs illustrating the results of a Bayesian analysis, which examined the specificity of the activation observed in OP1 (RH: x = 56, y = −23, z = 21; LH: x = −48, y = −17, z = 21) and dpINS (RH: x = 39, y = −15, z = 18; LH: x = −39, y = −9, z = 23) for physical pain. Bars represent the probability that a study activating a region within 10 mm of the peak coordinate in OP1 (red and orange bars) and dpINS (blue and green bars) belonged to that task category (i.e., the positive predictive value for each task type). Error bars represent one SE. “n” refers to the number of each type of study included in the meta-analysis.
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